Lacroix H, Van Hemelrijk J, Nevelsteen A, Suy R
Department of Vascular Surgery, University Hospital of Leuven, Belgium.
Acta Chir Belg. 1994 Jan-Feb;94(1):1-6.
In this non-randomised retrospective study we have compared 79 cases with transperitoneal approach and 90 cases with extended postero-lateral extraperitoneal approach for elective reconstruction of the infrarenal aorta. In the extraperitoneal group more patients were diabetic (7.8% vs 1.3%, p < 0.05) or had a serum creatinine of more than 1.5 mg % (10.1% vs 2.5%, p < 0.05). The study shows that in spite of a higher proportion of risk factors, a longer preparation (61' vs 44', p < 0.001), dissection (55' vs 46', p < 0.05) and total procedure time (193' vs 173', p < 0.05), the need for more blood transfusion (2.8 U vs 2.3 U, p < 0.05) and colloid perfusion (2.1 L vs 1.8 L, p < 0.05) in the extraperitoneal group, the incidence of complications is not higher compared to the transperitoneal group (29% vs 24%, NS). On the contrary, problems of intestinal transit were found exclusively in the transperitoneal group (7.6%, p < 0.01). Therefore it seems that, as far as the peri- and postoperative period is concerned the extraperitoneal approach might be the technique of choice for the simple elective infrarenal aorta reconstructions.
在这项非随机回顾性研究中，我们比较了79例采用经腹途径和90例采用扩大后外侧腹膜外途径进行择期肾下腹主动脉重建的病例。腹膜外组中糖尿病患者更多（7.8%对1.3%，p<0.05）或血清肌酐超过1.5mg%的患者更多（10.1%对2.5%，p<0.05）。研究表明，尽管腹膜外组危险因素比例更高、准备时间更长（61分钟对44分钟，p<0.001）、解剖时间更长（55分钟对46分钟，p<0.05）以及总手术时间更长（193分钟对173分钟，p<0.05），且需要更多的输血（2.8单位对2.3单位，p<0.05）和胶体灌注（2.1升对1.8升，p<0.05），但其并发症发生率与经腹组相比并不更高（29%对24%，无统计学差异）。相反，肠道蠕动问题仅在经腹组中出现（7.6%，p<0.01）。因此，就围手术期和术后阶段而言，腹膜外途径似乎可能是简单择期肾下腹主动脉重建的首选技术。
